Drive Through Mastectomy

I've heard that insurance companies are trying to rush inpatient care. Is that going to happen to me?

Maggie Hampshire, RN, BSN, OCN of the Abramson Cancer Center of the University of Pennsylvania, responds:

Over the last ten years, public anger has been evoked over the move toward outpatient care after breast cancer surgery. The outrage has been expressed by policyholders over the efforts of insurance companies trying to reduce the costs of inpatient care. The medical community has responded by gathering evidence through various studies, which prove that shorter hospital stays may be possible. Nurses have quickly tried to develop new outpatient teaching programs to fill in the gaps before and after surgery. They have identified educational needs for women undergoing outpatient breast surgery and formulated nursing roles to meet these needs. However, patients have voiced their opinion in the form of a public outcry. Under heavy pressure from their constituents lawmakers are being forced to act.

Grass roots advocates, including breast cancer survivors, cite the unfeeling attitude of insurers who would think of sending a woman home to cope physically and emotionally so soon after losing a breast to cancer. This past year, with much help from the women's health lobbyists such as the National Breast Cancer Coalition, "drive-through mastectomy" will be a topic facing state legislatures. More than 80 bills on this topic were introduced in state legislatures in the first two months of the 1997 legislative sessions alone.

On an individual state level, New Jersey Senate has passed a bill that would require health insurance companies to cover a minimum of a 2-day hospital stay following a simple mastectomy and 72 hours following a modified radical mastectomy. The bill also would prevent insurance companies from requiring a doctor to obtain authorization before prescribing the 72 or 48 hours if he or she feels it is medically necessary for the patient.

As yet, there have been no hearings on this topic on the national level; however, One lawmaker's experience after breast cancer surgery may push government officials to force the issue. Louise V. Snodgrass, a Republican representative from Maryland, told the Senate Finance Committee that minutes after her breast surgery, hospital nurses asked if she was ready to go home. She was devastated.

Politicians are working on bills that would put a stop to this national trend. The House of Representatives has approved legislation that would end the practice of "drive-through" mastectomies. This measure, "The Breast Cancer Patient Protection Act" (H.R. 135), would require insurance companies to provide at least 48 hours of inpatient hospital care following a mastectomy and a minimum of 24 hours following a lymph node dissection for the treatment of breast cancer. The proposal allows for shorter hospital stays if a woman and her physician agree. The legislation also requires insurance companies to pay for hospital stays longer than 48 hours if the patient and/or doctor feel it is necessary. This legislation was introduced by Rep. Rosa DeLauro (D-CT), Rep. John Dingell (D-MI), and Rep. Marge Roukema (R-NJ) It was passed on to the House Commerce Committee and its Subcommittee on Health and the Environment, as well as the House Committee on Education and the Workforce and its Subcommittee on Employer-Employee Relations.

Public support is needed in order to make sure that this bill becomes a law.

At OncoLink, we feel that this issue goes far beyond mastectomies. Our concern is that by establishing a precedent for such "drive through procedures" it will be possible to apply such care to less politically-charged cancer treatments. Although few will argue against measures that will effectively cut costs of cancer care, there are certainly immesurable costs that need to be considered. Among others, these include the real-dollar cost to family and friends who must miss work in order to physically care for their loved ones at home. But more importantly, no price tag can be placed on the emotional expense to these patients and their families left to cope on their own with the mental and spiritual burden of breast cancer.